If yes, please list the organization(s), certification(s), and licensing:

In your own words, briefly explain why you would like to become a Birth Boot Camp DOULA:*

What are you most looking forward to learning at your Birth Boot Camp DOULA Training Workshop?*

Who can we thank for referring you to Birth Boot Camp?

Please select your preferred payment option:*

Payment in fullPayment of $300 deposit with remaining balance set up in a payment plan. {payment plans will add an additional 7% to your fees} Final payment will be due no later than 2 weeks prior to the selected workshop.

Cancellation Policy: - A deposit of $300 is required to hold your spot at the workshop and is non-refundable. - If cancellation is made within two weeks of the workshop, no refund will be given. - Payment will be applied to the Birth Boot Camp DOULA workshop that is selected. If applicant desires to change to a later workshop date, a $100 fee will be applied. This $100 fee is due immediately to reserve the applicant’s spot in the new workshop. All fees are forfeited if applicant does not attend a workshop within 12 months of registering. - If Birth Boot Camp cancels the workshop for any reason, the entire fee will be refunded. - A refund will not be given if you do not complete the certification.*

Terms: - I understand that all pre-workshop requirements must be completed before attending the workshop. - As a participant of this training, I agree to allow Birth Boot Campto publish my information: name, city, state, phone number, and email address for the online listing. - I verify that all of the information given in this application is true. - I understand that photographs and video will be taken the workshop which may include me. I agree to allow Birth Boot Camp to use these photographs and video for full promotional purposes both online and in print. - I will allow Birth Boot Camp to use quotes from my training evaluations - which I may fill out anonymously - for promotional purposes online and in print. - Birth Boot Camp reserves the right to reject any applications for Doula Certification.*

Non-compete/non-disclosure: Before completing your Birth Boot Camp DOULA training, you will be asked to sign a non-complete/non-disclosureagreement. The Birth Boot Camp family is large and spread across the globe. Signing of the non-compete/non-disclosure simply ensures protection of the brand for all of the hundreds of other birth professionals that depend on the name for their own financial security. This does not prevent birth work, should you leave the company. It does, however, mean that upon signing you agree to not intentionally harm the name of Birth Boot Camp, use copyrighted materials, conduct trainings, or start a competing company. We are happy to answer any questions you may have.

I acknowledge and agree with all Fee Requirements and Policies, as listed above.

Please select the training workshop you would like to attend. If you decide to change your workshop date, a $100 fee applies.*